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Proper surgery selection important in treating newborn primary congenital glaucoma
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WASHINGTON — Patients with newborn primary congenital glaucoma have a better chance of successful surgery if glaucoma drainage devices or trabeculectomies are performed instead of goniosurgery, a study found.
David S. Walton, MD, and Garyfallia Katsavounidou, MS, performed a study review of 42 patients who had newborn primary congenital glaucoma and were from a larger study group of 356 patients with primary congenital glaucoma. Dr. Walton presented the results at the American Glaucoma Society annual meeting.
Of the 42 patients reviewed, 19 were boys and 23 were girls. The diagnosis of newborn primary congenital glaucoma was made between 0 days and 3 days in 95% of cases. The main diagnostic sign in patients was bilaterally cloudy corneas (98%), Dr. Walton said. Patients also had abnormally deep anterior chambers, abnormal irides and angles.
"The corneas are very cloudy and somewhat large, and they can have very dense center areas," Dr. Walton said.
He said that newborn primary congenital glaucoma is a subset of primary congenital glaucoma, which is the most common cause of hereditary glaucoma in infancy. Early diagnosis of the disease is important for lowering pressure and having successful surgery, he said.
Patients with newborn primary congenital glaucoma have more severe anterior abnormalities that require different management and treatment than infantile primary congenital glaucoma, Dr. Walton said. While goniosurgery is successful in many glaucoma cases, he said he found that only 8% of goniosurgery procedures were successful in newborn primary congenital glaucoma. In contrast, 25% of trabeculectomies and 65% of glaucoma drainage device procedures were successful.
While the glaucoma drainage devices require monitoring in these young children, Dr. Walton said the benefits of the devices outweigh the maintenance.